Objective:

To explore the association between intracranial hypertension (IH) in patients with multiple sclerosis (MS) as well as assess shared characteristics between the two disorders, such as risk factors, demographics, and other relevant factors. 

Background:

IH has been studied in relation to multiple autoimmune neurological conditions like myelin oligodendrocyte glycoprotein antibody-associated disease and neuromyelitis optica; however, its association with MS is underexplored.

Design/Methods:

This retrospective case series was conducted in two hospitals in Atlanta, Georgia. Patients that were 18 years old or older, with new onset optic neuritis (ON) secondary to MS, an opening pressure (OP) ≥ 25 cmH2O on lumbar puncture (LP) and were admitted between 1/1/18 and 2/28/25 were included in this study. Patients with a prior history of IH and/or MS were excluded.  

Results:

A total of 498 patients with ON secondary to MS were identified; 71.5% did not undergo LP and 5.0% of which had an OP ≥ 25 cmH2O. Nine patients that fully met inclusion criteria were identified. The mean age was 32.1 and 88.9% of the patients were female and Black. The most common presenting symptoms were blurry vision (100%), decreased visual acuity (100%), and headaches (55.6%). Disc edema was identified in 55.6% of patients. The mean OP was 31.5 (range 26-42) cm H2O. Radiologic findings included unilateral nerve enhancement (66.7%), bilateral nerve enhancement (22.2), partially empty sella (55.6%), and transverse sinus stenosis (44.4%). Patients were treated with IV methylprednisone (100%), plasma exchange (22.2%), and/or diamox (11.1%). All patients showed improvement in visual acuity after treatment. 

Conclusions:

IH and ON secondary to MS have many overlapping symptoms and radiologic findings consistent with each disease separately but concurrently. We found no evidence of worse visual outcomes in patients with IH and ON. Awareness of this relationship is important as it can help guide diagnostic evaluation and management.